Dr. Anson Cheung performs a transplant of a LVAD, or left ventricular assist device, to the heart of Craig Watson July 16, 2012 at St. Paul's Hospital.Jason Payne
/ PNG

Craig Watson at St. Paul's Hospital Sunday, the day before he receives a mechanical heart implant. Mr. Watson is a 45-year-old lawyer and father of three children.Kim Stallknecht
/ PNG

Surgical instruments ready for use as Dr. Anson Cheung, assisted by Dr. Michael Yamashita, perform a transplant of a LVAD, or left ventricular assist device, to the heart of patient Craig Watson of Richmond July 16, 2012 at St. Paul's Hospital in Vancouver.Jason Payne
/ PNG

Dr. Anson Cheung (centre), assisted by Dr. Michael Yamashita (right) and scrub nurse Wayne Barry (left), perform a transplant of a LVAD, or left ventricular assist device, to the heart of patient Craig Watson of Richmond on July 16, 2012 at St. Paul's Hospital in Vancouver.Jason Payne
/ PNG

Gouts of hot red blood spurt from Craig Watson’s heart as world-renowned cardiac surgeon Dr. Anson Cheung plunges his blade into the organ in Operating Room 14 at St. Paul’s Hospital. Watson, of Richmond, has dilated cardiomyopathy, a condition that has bloated his heart to three times its normal size and weakened its ability to pump blood throughout his body.

“They can actually get a blood clot in there because the blood gets so stagnant,” says cardiologist Dr. Mary Lynn Brumwell, assisting during the surgery.

Watson, a lawyer and married father of three, had a pacemaker installed in 2006, and in 2007 suffered two “transient ischemic attacks” — also known as “mini-strokes.” He’d been doing fine, ­however, until getting food poisoning in ­Mexico in 2011, which disrupted his body’s ­electrolyte balance and ­exacerbated his condition.

It is July 16, and Watson is in the ­process of becoming the 101st patient at St. Paul’s to receive an implanted heart pump, known as a ventricular-assist device (VAD). Watson is anesthetized, lying unconscious with a nest of tubes and wires surrounding his ashen head. Blue fabric is draped over his body, except for his torso, which is covered with a ­transparent adhesive film.

The operation starts at 9:30 a.m. As Brumwell prepares the VAD — an $85,000 titanium-and-Dacron device resembling a car’s gas cap with a metal stem at the bottom and a fabric tube coming off the side — Cheung uses an electro-cautery tool to slice open the flesh of Watson’s chest.

The smell of burnt tissue rises from the incision, Cheung’s deft slices revealing a layer of globular yellow fat above the breastbone. Then the surgeon ­plunges a saw blade into the lower end of the cut, bearing down hard and pushing the blade upward. The blade rips through the sternum in less than three seconds.

Cheung sets a retractor device into the incision, and cranks a handle to spread the split rib cage apart. Within the gap created lies Watson’s beating heart, ­covered by a thin membrane. Cheung slices open the membrane and fastens it out of the way with temporary sutures. Watson’s heart swells into the opening in his chest, the pink and purple, fat-blotched organ rising and falling as it ­feebly pumps. On either side of it, the sawn-off ribs appear in cross-section, like a cut from the ­butcher shop.

“Do we have a bigger retractor?” ­Cheung asks scrub nurse Wayne ­Barry. Barry grabs one and gives it to Cheung, who replaces the smaller one, then cranks open Watson’s chest again. The surgeon takes a strip of cloth and feeds it beneath the heart, then uses it to lift the organ up so it protrudes from the rent in Watson’s breast. Moving the heart has caused a drop in blood pressure. While Cheung waits for the pressure to rise back up, he cuts a small hole in Watson’s abdomen. The power and control cord for the VAD will come out of that hole.

Barry puts a dozen or so forceps down on the fabric covering Watson’s legs, and he and Brumwell clamp a curved needle and length of suturing thread into each set of forceps. Cheung takes these and starts sewing a toonie-sized titanium ring onto the left ventricle of Watson’s heart. The VAD will be screwed onto this ring, after Cheung cuts a hole in the heart below the middle of the ring. ­Cheung’s hands move in a near-blur as he ties knots to fasten down the ring.

Next, however, the surgeon must open a passage for the VAD’s cord. He takes a long metal spear-like rod, bends it into a slight curve, and pushes it into the hole he had cut earlier. Leaning in, he rams the rod’s pointed tip upward, through Watson’s abdominal muscles and into the heart cavity. He attaches the VAD cord to the tip, then pulls it and the cord back out.

Now Cheung is ready to pierce the heart. “It’s going to be bloody,” he says, “just for 10 seconds.”

Cheung pushes an instrument into the heart tissue within the ring and starts cutting. The fountain of blood covers Dr. Michael Yamashita, who is assisting Cheung, and splashes onto the floor. Cheung takes the VAD and inserts its stem into Watson’s heart, then screws the VAD onto the ring sewn onto the heart’s surface. Blood will flow into the pump via the stem, and exit through the Dacron tube, which must be attached to Watson’s aorta, the large artery that comes out of the top of the heart.

The surgeon clamps off only part of the aorta, to allow it to continue carrying blood, and makes an incision in the clamped-off portion. He sutures the end of the tube to the cut in the aorta, and squeezes glue around the stitches to stop the bleeding. Cheung then begins manipulating the tube and pricking it with a needle to let any air inside escape. “If there’s air in there and it gets to the brain it can cause a stroke,” Brumwell says.

An hour and a half after Cheung first sliced open Watson, the surgeon tells an assistant to start the pump.

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